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B. D. ayres, S. Airiani, J. D. Zahler, M. Moster, I. M. Raber; Early Results of Descemet’s Stripping Automated Endothelial Keratoplasty in Post-Glaucoma Surgery Eyes. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2216.
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To report the early results of Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) in patients who had undergone glaucoma surgery.
Thirty-eight cases of corneal endothelial dysfunction in patients who had undergone at least one type of glaucoma surgery and then underwent DSAEK surgery were included in the study. All patients underwent either DSAEK surgery alone or with simultaneous glaucoma tube shunt implant or revision. Preoperative and postoperative best corrected visual acuity, intraocular pressure, attachment and dislocation rate as well as primary graft failure and rejection event were retrospectively reviewed.
Mean subject age was 76 ± 10 years and 58% had pseudophakic bullous keratopathy and 26% had failed penetrating keratoplasty. Twenty nine patients had trabeculectomy, and 14 had anterior chamber tube shunt. Average preoperative and postoperative intraocular pressures were 12.7±4.5 mmHg and 12.7±4.8 mmHg. Early postoperative donor disc detachment occurred in 8 (21%) patients at 1-day postoperative examination and 5 (13%) at 1-week follow up. Eleven of 13 (85%) donor discs were successfully reattached by injecting an air bubble at the slit lamp to press the donor against the recipient cornea. Two were returned to the operating room for graft repositioning. Of the 24 patients with recorded status of air bubble in the anterior chamber on postoperative day 1, only 7 (29%) still have a 30-40% bubble in the anterior chamber. There were 2 (5.2%) primary graft failures. There was not a single case of pupillary block in the entire series. After DSAEK surgery, the average LogMAR best corrected visual acuity (BCVA) improved from 1.16 (20/300) to 0.60 (20/80); P<0.001. Twelve patients obtained BCVA of 20/50 or better postoperatively.
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